FORMULIR 2.B.

PEMANTAUAN BULANAN ANAK 0-2 TAHUN

BULAN :JANUARI 2021

Umur dan Status
Indikator Layanan

Jenis Kelamin (L/P)

Tikar
Status Gizi

Konseling Gizi Bagi

Kepemilikan Akses
No Tanggal Lahir Anak

Pengukuran Tinggi

Kunjungan Rumah
Pengukuran Berat
Imunisasi Dasar

Jamban Sehat
No Register Nama Anak Anak (Normal/Buruk

Kepemilikan
Pemberian

Orang Tua

Air Bersih
(KIA) (Tgl/Bln/Thn) /Kurang/Stunti

Badan

Badan
ng) Umur Hasil
(Bulan) (M/K/H)

a b c d e f g h i j k1 (L) k2 (P) l m n

1 M. HABIL L 28/12/20 N 24 H v v v x x x v v
2 AZZAM A.L. L 28/12/20 N 24 H v v v x x x v v
3 KHENZIE A. L 15/12/20 N 24 H v v v x x x v v
4 YULIANA SARI P 07/02/20 N 24 H v v v x x x v v
5 ANASYA A.S. P 03/02/20 N 23 H v v v x x x v v
6 MAHESA L 12/02/20 N 23 H v v v x x x v v
7 L. RASYA L 22/01/20 N 24 H v v v x x x v v
8 FAHMA P 12/02/20 N 23 H v v v x x x v v
9 M. ARFA L 03/04/20 N 22 H v v v x x x v v
10 A. IKBAL M. L 14/02/20 N 24 H v v v x x x v v
11 ELVINA P 23/03/20 N 23 H v v v x x x v v
12 ABDILLAH S L 11/03/20 N 23 H v v v x x x v v
13 ZAFINA C.A. P 20/04/20 N 22 H v v v x x x v v
14 AISYAH N. P 14/04/20 N 22 H v v v x x x v v
15 M. NAZIL A.R. L 17/04/20 N 22 H v v v x x x v v
16 LAISYA P 13/04/20 N 22 H v v v x x x v v
17 RAIHANA Y. P 20/03/20 N 23 H v v v x x x v v
18 ZAFRAN L 14/04/20 N 23 H v v v x x x v v
19 MUSAIBAH P 22/02/20 N 24 H v v v x x x v v
20 ALISIA P 27/03/20 N 24 H v v v x x x v v
21 ASHIMA P 02/04/20 N 22 H v v v x x x v v
22 ARMAN MAULANA L 14/03/20 N 23 H v v v x x x v v
23 M. ARFA L 03/04/20 N 22 H v v v x x x v v
24 YUKI KIANA P 18/05/20 N 21 H v v v x x x v v
25 AROYAN DILAN L 22/04/20 N 22 H v v v x x x v v
26 MERISA B.A. P 06/05/20 N 21 H v v v x x x v v
27 AUDI SYAHILA H. P 02/07/20 N 19 H v v v x x x v v
28 ZHAKIA ARZUMIS P 20/07/20 N 18 H v v v x x x v v
29 ARMAN F. L 09/06/20 N 19 H v v v x x x v v
30 M. DAVI L 15/05/20 N 20 H v v v x x x v v
31 M. DAVA L 15/05/20 N 21 H v v v x x x v v
32 UMI HANI P 29/05/20 N 21 H v v v x x x v v
33 DEFFIN R. L 17/04/20 N 22 H v v v x x x v v
34 DIANDRA NUR E. P 15/07/20 N 19 H v v v x x x v v
35 KHAIRUNISA P 23/07/20 N 19 H v v v x x x v v
36 M. ABIDZAR L 17/07/20 N 19 H v v v x x x v v
37 RUHANA ULUMI P 04/08/20 S 19 M v v v v v v v v
38 HANAN ALWI L 25/07/20 N 19 H v v v x x x v v
39 MAFAZA H. P 21/08/20 N 18 H v v v x x x v v
40 L. ABIZAR H. L 03/08/20 N 18 H v v v x x x v v
41 M. RAYYAN L 07/08/20 N 18 H v v v x x x v v
42 FANAZAIN L 25/07/20 N 19 H v v v x x x v v
43 M. ARTA L 05/09/20 N 17 H v v v x x x v v
44 M. ALFATIH L 03/09/20 N 17 H v v v x x x v v
45 ALENA Y. P 28/08/20 N 18 H v v v x x x v v
46 YUMNA A. P 15/09/20 N 17 H v v v x x x v v
47 SAFIRA P 15/09/20 N 17 H v v v x x x v v
48 ARNI G. P 24/10/20 N 14 H v v v x x x v v
49 ABIMANYU L 09/09/20 N 17 H v v v x x x v v
50 XKHAYLA S. P 04/09/20 N 17 H v v v x x x v v
51 AHMAD B. R. L 08/10/20 N 14 H v v v x x x v v
52 SHAFIA M. P 15/10/20 N 16 H v v v x x x v v
53 MUFIDA P 20/01/20 N 13 H v v v x x x v v
54 RAFIF A R L 14/12/20 N 14 H v v v x x x v v
55 RASYA O P 5/10/2019 N 16 H v v v x x x v v
56 M.RIFKI L 30/07/20 N 19 H v v v x x x v v
57 SYEHAN ZAIN L 6/11/2020 BGT 16 M v v v v v v v v
58 DYLAN ELKHAN L 9/12/2020 N 15 H v v v x x x v v
59 HANANIA P 17/10/20 N 17 H v v v x x x v v
60 A.BRILIAN L 8/10/2020 N 16 H v v v x x x v v
61 ZAHIRUL L 14/11/20 N 15 H v v v x x x v v
62 CARTO LITA L 17/11/20 N 15 H v v v x x x v v
63 M.RAMA F L 8/5/2020 N 19 H v v v x x x v v
64 M.FADLAN L 27/10/20 N 16 H v v v x x x v v
65 AFIFAH H P 10/11/2020 N 15 H v v v x x x v v
66 NUWAIRA A P 1/11/2020 N 15 H v v v x x x v v
67 M.MIZAN L 23/10/20 N 16 H v v v x x x v v
68 M.AZRIL R L 5/11/2020 N 15 H v v v x x x v v
69 NADIA O P 2/10/2020 N 16 H v v v x x x v v
70 NASYA P 2/11/2020 N 15 H v v v x x x v v
71 MUFIDA P 20/01/20 N 13 H v v v x x x v v
72 GIBRAN A L 24/01/20 N 23 H v v v x x x v v
73 M.RAFA L 5/3/2020 N 22 H v v v x x x v v
74 DYLAN AL L 17/04/20 N 21 H v v v x x x v v
75 DEFFIN A L 20/06/20 N 20 H v v v x x x v v
76 M.ZULKIFLI L 20/06/20 N 20 H v v v x x x v v
77 ARSYAKA N P 7/7/2020 N 20 H v v v x x x v v
78 VANNO ZEAN L 25/07/20 N 20 H v v v x x x v v
79 AZLAN M L 12/8/2020 N 18 H v v v x x x v v
80 M.RAFA A L 16/07/20 N 20 H v v v x x x v v
81 M.ARKA L 9/9/2019 N 17 H v v v x x x v v
82 DEFITA P 6/12/2020 N 14 H v v v x x x v v
83 LAILA P 3/1/2021 S 13 M v v v v v v v v
84 M ALWISYAPUTRA L 13/01/201 N 13 H v v v x x x v v
85 NATASYA P 9/12/2020 N 14 H v v v x x x v v
86 M.KEVIN L 25/12/20 N 14 H v v v x x x v v
87 EFRINA P 10/12/2020 N 14 H v v v x x x v v
88 DESI L P 22/12/20 N 14 H v v v x x x v v
89 M.ALBIYAN L 24/12/20 N 14 H v v v x x x v v
90 A.ALFARIZKI L 7/12/2020 N 13 H v v v x x x v v
91 RAFIF R L 14/12/20 N 13 H v v v x x x v v
92 KENZIE. A L 23/01/21 N 13 H v v v x x x v v
93 PRATAMA F L 4/2/2021 N 12 H v v v x x x v v
94 HANIFAH R P 13/02/21 N 12 H v v v x x x v v
95 NAFISA H P 10/2/2021 N 12 H v v v x x x v v
96 KATINA P P 4/3/2021 N 10 H v v v x x x v v
97 IZZKY L 7/3/2021 N 10 H v v v x x x v v
98 NURUL F P 28/2/21 N 9 H v v v x x x v v
99 L.HAFAN L 22/2/21 N 9 H v v v x x x v v
100 HALWA P 1/4/2021 N 9 H v v v x x x v v
101 KENZO AS L 2/4/2021 N 8 H v v v x x x v v
102 CLAUDIAR P 12/3/2021 N 10 H v v v x x x v v
103 A SAURI L 23/4/21 N 9 H v v v x x x v v
104 MEGA TITI A P 15/5/21 N 8 H v v v x x x v v
105 M.YAHYA L 21/4/21 N 9 H v v v x x x v v
106 ZASKIA PA P 1/4/2021 N 9 H v v v x x x v v
107 SYAQILLA A P 9/5/2021 N 8 H v v v x x x v v
108 M ABIZAR L 1/5/2021 N 8 H v v v x x x v v
109 KHAYLA Z P 20/6/21 N 7 H v v v x x x v v
110 AZKA ADI L 18/6/21 N 7 H v v v x x x v v
111 DIAH A P 19/6/21 N 7 H v v v x x x v v
112 AMALIYA HN P 10/6/2021 N 7 H v v v x x x v v
113 HABIBAH F P 22/6/21 N 7 H v v v x x x v v
114 ARUMI NZ P 6/6/2021 N 7 H v v v x x x v v
115 RAZKA A L 29/6/21 N 7 H v v v x x x v v
116 ABDIKA P L 17/6/21 S 7 M v v v v v v v v
117 M.ARDIANNUR L 8/6/2021 N 7 H v v v x x x v v
118 M.RIZAL L 22/7/21 N 6 H v v v x x x v v
119 M.RIZKI S L 8/8/2021 N 5 TS v v v x x x v v
120 NUR AISYAH P 4/7/2021 N 6 H v v v x x x v v
121 RIZKYA P 26/7/21 N 6 H v v v x x x v v
122 ANDRI NK L 30/7/21 N 6 H v v v x x x v v
123 NUR ROSIDAH P 19/7/21 N 6 H v v v x x x v v
124 A.RIDHANI L 3/7/2021 N 6 H v v v x x x v v
125 RAFA A L 6/7/2021 N 6 H v v v x x x v v
126 M.FAQIH L 23/7/21 N 6 H v v v x x x v v
127 ZAHIRA N P 7/7/2021 N 6 H v v v x x x v v
128 AINUN N P 9/8/2021 N 5 TS TS TS TS TS TS TS v v
129 M.AZAN L 27/9/21 N 4 TS TS TS TS TS TS TS v v
130 AISYAH N L P 27/8/21 N 5 TS TS TS TS TS TS TS v v
131 QIRANA E P 20/8/21 N 5 TS TS TS TS TS TS TS v v
132 ELVANO M L 10/9/21 N 4 TS TS TS TS TS TS TS v v
133 SEPTIA NA P 10/9/21 N 4 TS TS TS TS TS TS TS v v
134 L.ARFADIHILA L 6/10/21 N 3 TS TS TS TS TS TS TS v v
135 GAITSA R P 20/10/21 N 3 TS TS TS TS TS TS TS v v
136 KHOIROTUN P 14/9/21 N 4 TS TS TS TS TS TS TS v v
137 ZIDAN AL L 20/11/21 N 2 TS TS TS TS TS TS TS v v
138 IRSYAD L 20/12/21 N 1 TS TS TS TS TS TS TS v v
139 VELICIA P 14/10/21 N 3 TS TS TS TS TS TS TS v v
nan Pengasuhan
Kesehatan
Akta Lahir
Jaminan

(PAUD)

o p q

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 FORMULIR 2.B. PEMANTAUAN BULANAN A

BULAN :februari 2021

Jenis Kelamin (L/P)

Status Gizi Umur dan
No Tanggal Anak Status Tikar
Lahir
Regist (Normal/B

Pemberian
No Nama Anak Anak

Imunisasi
er Umur Hasil
(Tgl/Bl uruk/Kura (Bulan (M/K/

Dasar
(KIA) ng/Stuntin
n/Thn) ) H)
g)

a b c d e f g h

1 ANASYA A.S. P 03/02/20 N 24 H v

2 MAHESA L 12/02/20 N 24 H v
3 FAHMA P 12/02/20 N 24 H v
4 M. ARFA L 03/04/20 N 23 H v
5 ELVINA P 23/03/20 N 24 H v
6 ABDILLAH S L 11/03/20 N 24 H v
7 ZAFINA C.A. P 20/04/20 N 23 H v
8 AISYAH N. P 14/04/20 N 23 H v
9 M. NAZIL A.R. L 17/04/20 N 23 H v
10 LAISYA P 13/04/20 N 23 H v
11 RAIHANA Y. P 20/03/20 N 24 H v
12 ZAFRAN L 14/04/20 N 24 H v
13 ASHIMA P 02/04/20 N 23 H v
14 ARMAN MAULANA L 14/03/20 N 24 H v
15 M. ARFA L 03/04/20 N 23 H v
16 YUKI KIANA P 18/05/20 N 22 H v
17 AROYAN DILAN L 22/04/20 N 23 H v
18 MERISA B.A. P 06/05/20 N 22 H v
19 AUDI SYAHILA H. P 02/07/20 N 20 H v
20 ZHAKIA ARZUMIS P 20/07/20 N 19 H v
21 ARMAN F. L 09/06/20 N 20 H v
22 M. DAVI L 15/05/20 N 21 H v
23 M. DAVA L 15/05/20 N 22 H v
24 UMI HANI P 29/05/20 N 22 H v
25 DEFFIN R. L 17/04/20 N 23 H v
26 DIANDRA NUR E. P 15/07/20 N 20 H v
27 KHAIRUNISA P 23/07/20 N 20 H v
28 M. ABIDZAR L 17/07/20 N 20 H v
29 RUHANA ULUMI P 04/08/20 S 20 M v
30 HANAN ALWI L 25/07/20 N 20 H v
31 MAFAZA H. P 21/08/20 N 19 H v
32 L. ABIZAR H. L 03/08/20 N 19 H v
33 M. RAYYAN L 07/08/20 N 19 H v
34 FANAZAIN L 25/07/20 N 20 H v
35 M. ARTA L 05/09/20 N 18 H v
36 M. ALFATIH L 03/09/20 N 18 H v
37 ALENA Y. P 28/08/20 N 19 H v
38 YUMNA A. P 15/09/20 N 18 H v
39 SAFIRA P 15/09/20 N 18 H v
40 ARNI G. P 24/10/20 N 15 H v
41 ABIMANYU L 09/09/20 N 18 H v
42 XKHAYLA S. P 04/09/20 N 18 H v
43 AHMAD B. R. L 08/10/20 N 15 H v
44 SHAFIA M. P 15/10/20 N 17 H v
45 MUFIDA P 20/01/20 N 14 H v
46 RAFIF A R L 14/12/20 N 15 H v
47 RASYA O P 5/10/2019 N 17 H v
48 M.RIFKI L 30/07/20 N 20 H v
49 SYEHAN ZAIN L 6/11/2020 BGT 17 M v
50 DYLAN ELKHAN L 9/12/2020 N 16 H v
51 HANANIA P 17/10/20 N 18 H v
52 A.BRILIAN L 8/10/2020 N 17 H v
53 ZAHIRUL L 14/11/20 N 16 H v
54 CARTO LITA L 17/11/20 N 16 H v
55 M.RAMA F L 8/5/2020 N 20 H v
56 M.FADLAN L 27/10/20 N 17 H v
57 AFIFAH H P 10/11/2020 N 16 H v
58 NUWAIRA A P 1/11/2020 N 16 H v
59 M.MIZAN L 23/10/20 N 17 H v
60 M.AZRIL R L 5/11/2020 N 16 H v
61 NADIA O P 2/10/2020 N 17 H v
62 NASYA P 2/11/2020 N 16 H v
63 MUFIDA P 20/01/20 N 14 H v
64 GIBRAN A L 24/01/20 N 24 H v
65 M.RAFA L 5/3/2020 N 23 H v
66 DYLAN AL L 17/04/20 N 22 H v
67 DEFFIN A L 20/06/20 N 21 H v
68 M.ZULKIFLI L 20/06/20 N 21 H v
69 ARSYAKA N P 7/7/2020 N 21 H v
70 VANNO ZEAN L 25/07/20 N 21 H v
71 AZLAN M L 12/8/2020 N 19 H v
72 M.RAFA A L 16/07/20 N 21 H v
73 M.ARKA L 9/9/2019 N 18 H v
74 DEFITA P 6/12/2020 N 15 H v
75 LAILA P 3/1/2021 S 14 M v
76 M ALWISYAPUTRA L 13/01/201 N 14 H v
77 NATASYA P 9/12/2020 N 15 H v
78 M.KEVIN L 25/12/20 N 15 H v
79 EFRINA P 10/12/2020 N 15 H v
80 DESI L P 22/12/20 N 15 H v
81 M.ALBIYAN L 24/12/20 N 15 H v
82 A.ALFARIZKI L 7/12/2020 N 14 H v
83 RAFIF R L 14/12/20 N 14 H v
84 KENZIE. A L 23/01/21 N 14 H v
85 PRATAMA F L 4/2/2021 N 13 H v
86 HANIFAH R P 13/02/21 N 13 H v
87 NAFISA H P 10/2/2021 N 13 H v
88 KATINA P P 4/3/2021 N 11 H v
89 IZZKY L 7/3/2021 N 11 H v
90 NURUL F P 28/2/21 N 10 H v
91 L.HAFAN L 22/2/21 N 10 H v
92 HALWA P 1/4/2021 N 10 H v
93 KENZO AS L 2/4/2021 N 9 H v
94 CLAUDIAR P 12/3/2021 N 11 H v
95 A SAURI L 23/4/21 N 10 H v
96 MEGA TITI A P 15/5/21 N 9 H v
97 M.YAHYA L 21/4/21 N 10 H v
98 ZASKIA PA P 1/4/2021 N 10 H v
99 SYAQILLA A P 9/5/2021 N 9 H v
100 M ABIZAR L 1/5/2021 N 9 H v
101 KHAYLA Z P 20/6/21 N 8 H v
102 AZKA ADI L 18/6/21 N 8 H v
103 DIAH A P 19/6/21 N 8 H v
104 AMALIYA HN P 10/6/2021 N 8 H v
105 HABIBAH F P 22/6/21 N 8 H v
106 ARUMI NZ P 6/6/2021 N 8 H v
107 RAZKA A L 29/6/21 N 8 H v
108 ABDIKA P L 17/6/21 S 8 M v
109 M.ARDIANNUR L 8/6/2021 N 8 H v
110 M.RIZAL L 22/7/21 N 7 H v
111 M.RIZKI S L 8/8/2021 N 6 H v
112 NUR AISYAH P 4/7/2021 N 7 H v
113 RIZKYA P 26/7/21 N 7 H v
114 ANDRI NK L 30/7/21 N 7 H v
115 NUR ROSIDAH P 19/7/21 N 7 H v
116 A.RIDHANI L 3/7/2021 N 7 H v
117 RAFA A L 6/7/2021 N 7 H v
118 M.FAQIH L 23/7/21 N 7 H v
119 ZAHIRA N P 7/7/2021 N 7 H v
120 AINUN N P 9/8/2021 N 6 H v
121 M.AZAN L 27/9/21 N 5 TS v
122 AISYAH N L P 27/8/21 N 6 H v
123 QIRANA E P 20/8/21 N 6 H v
124 ELVANO M L 10/9/21 N 5 TS TS
125 SEPTIA NA P 10/9/21 N 5 TS TS
126 L.ARFADIHILA L 6/10/21 N 4 TS TS
127 GAITSA R P 20/10/21 N 4 TS TS
128 KHOIROTUN P 14/9/21 N 5 TS TS
129 ZIDAN AL L 20/11/21 N 3 TS TS
130 IRSYAD L 20/12/21 N 2 TS TS
131 VELICIA P 14/10/21 N 4 TS TS
132 M.YUSUF A L 9/12/2021 N 2 TS TS
133 NUR BAGUS L 7/12/2021 N 2 TS TS
134 M.AL.AMIN L 2/1/2022 N 1 TS TS
135 M.BAHTIAR L 13/12/21 N 2 TS TS
ANTAUAN BULANAN ANAK 0-2 TAHUN

ari 2021
Indikator Layanan

Konseling Gizi

Jamban Sehat
Tinggi Badan

Kepemilikan

Kepemilikan
Berat Badan

Pengasuhan
Pengukuran

Pengukuran

Bagi Orang

Kunjungan

Kesehatan
Akta Lahir
Akses Air

Jaminan

(PAUD)
Rumah

Bersih
Tua
i j k1 (L) k2 (P) l m n o p q

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v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v v x
v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
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v v x x x v v v x x
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v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
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v v x x x v v v x x
 v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
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v v x x x v v v x x
v v x x x v v v x x
v v x x x v v v x x
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TS TS TS TS TS v v v x x
TS TS TS TS TS v v v x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
TS TS TS TS TS v v x x x
 FORMULIR 2.B. PEMANTAUAN BULANAN AN

Status BULAN :MARET 2021

Umur dan

Jenis Kelamin (L/P)

Gizi
Tangg Anak Status Tikar

Pengukuran Berat
No al

Imunisasi Dasar
(Norm
Regist Nama Lahir

Pemberian
No er Anak Anak al/Bur Umur Hasil

Badan
uk/Ku (Bulan (M/K/
(KIA) (Tgl/Bl
n/Thn) rang/S ) H)
tuntin
g)
a b c d e f g h i

1 M. ARFA L 03/04/20 N 23 H v v
2 ZAFINA C.A. P 20/04/20 N 23 H v v
3 AISYAH N. P 14/04/20 N 23 H v v
4 M. NAZIL A.R. L 17/04/20 N 23 H v v
5 LAISYA P 13/04/20 N 23 H v v
6 ASHIMA P 02/04/20 N 23 H v v
7 M. ARFA L 03/04/20 N 23 H v v
8 YUKI KIANA P 18/05/20 N 22 H v v
9 AROYAN DILAN L 22/04/20 N 23 H v v
10 MERISA B.A. P 06/05/20 N 22 H v v
11 AUDI SYAHILA H. P 02/07/20 N 20 H v v
12 ZHAKIA ARZUMIS P 20/07/20 N 19 H v v
13 ARMAN F. L 09/06/20 N 20 H v v
14 M. DAVI L 15/05/20 N 21 H v v
15 M. DAVA L 15/05/20 N 22 H v v
16 UMI HANI P 29/05/20 N 22 H v v
17 DEFFIN R. L 17/04/20 N 23 H v v
18 DIANDRA NUR E. P 15/07/20 N 20 H v v
19 KHAIRUNISA P 23/07/20 N 20 H v v
20 M. ABIDZAR L 17/07/20 N 20 H v v
21 RUHANA ULUMI P 04/08/20 S 20 M v v
22 HANAN ALWI L 25/07/20 N 20 H v v
23 MAFAZA H. P 21/08/20 N 19 H v v
24 L. ABIZAR H. L 03/08/20 N 19 H v v
25 M. RAYYAN L 07/08/20 N 19 H v v
26 FANAZAIN L 25/07/20 N 20 H v v
27 M. ARTA L 05/09/20 N 18 H v v
28 M. ALFATIH L 03/09/20 N 18 H v v
29 ALENA Y. P 28/08/20 N 19 H v v
30 YUMNA A. P 15/09/20 N 18 H v v
31 SAFIRA P 15/09/20 N 18 H v v
32 ARNI G. P 24/10/20 N 15 H v v
33 ABIMANYU L 09/09/20 N 18 H v v
34 XKHAYLA S. P 04/09/20 N 18 H v v
35 AHMAD B. R. L 08/10/20 N 15 H v v
36 SHAFIA M. P 15/10/20 N 17 H v v
37 MUFIDA P 20/01/20 N 14 H v v
38 RAFIF A R L 14/12/20 N 15 H v v
39 RASYA O P 5/10/2019 N 17 H v v
40 M.RIFKI L 30/07/20 N 20 H v v
41 SYEHAN ZAIN L 6/11/2020 BGT 17 M v v
42 DYLAN ELKHAN L 9/12/2020 N 16 H v v
43 HANANIA P 17/10/20 N 18 H v v
44 A.BRILIAN L 8/10/2020 N 17 H v v
45 ZAHIRUL L 14/11/20 N 16 H v v
46 CARTO LITA L 17/11/20 N 16 H v v
47 M.RAMA F L 8/5/2020 N 20 H v v
48 M.FADLAN L 27/10/20 N 17 H v v
49 AFIFAH H P 10/11/2020 N 16 H v v
50 NUWAIRA A P 1/11/2020 N 16 H v v
51 M.MIZAN L 23/10/20 N 17 H v v
52 M.AZRIL R L 5/11/2020 N 16 H v v
53 NADIA O P 2/10/2020 N 17 H v v
54 NASYA P 2/11/2020 N 16 H v v
55 MUFIDA P 20/01/20 N 14 H v v
56 M.RAFA L 5/3/2020 N 23 H v v
57 DYLAN AL L 17/04/20 N 22 H v v
58 DEFFIN A L 20/06/20 N 21 H v v
59 M.ZULKIFLI L 20/06/20 N 21 H v v
60 ARSYAKA N P 7/7/2020 N 21 H v v
61 VANNO ZEAN L 25/07/20 N 21 H v v
62 AZLAN M L 12/8/2020 N 19 H v v
63 M.RAFA A L 16/07/20 N 21 H v v
64 M.ARKA L 9/9/2019 N 18 H v v
65 DEFITA P 6/12/2020 N 15 H v v
66 LAILA P 3/1/2021 S 14 M v v
67 M ALWISYAPUTR L 13/01/201 N 14 H v v
68 NATASYA P 9/12/2020 N 15 H v v
69 M.KEVIN L 25/12/20 N 15 H v v
70 EFRINA P 10/12/2020 N 15 H v v
71 DESI L P 22/12/20 N 15 H v v
72 M.ALBIYAN L 24/12/20 N 15 H v v
73 A.ALFARIZKI L 7/12/2020 N 14 H v v
74 RAFIF R L 14/12/20 N 14 H v v
75 KENZIE. A L 23/01/21 N 14 H v v
76 PRATAMA F L 4/2/2021 N 13 H v v
77 HANIFAH R P 13/02/21 N 13 H v v
78 NAFISA H P 10/2/2021 N 13 H v v
79 KATINA P P 4/3/2021 N 11 H v v
80 IZZKY L 7/3/2021 N 11 H v v
 81 NURUL F P 28/2/21 N 10 H v v
82 L.HAFAN L 22/2/21 N 10 H v v
83 HALWA P 1/4/2021 N 10 H v v
84 KENZO AS L 2/4/2021 N 9 H v v
85 CLAUDIAR P 12/3/2021 N 11 H v v
86 A SAURI L 23/4/21 N 10 H v v
87 MEGA TITI A P 15/5/21 N 9 H v v
88 M.YAHYA L 21/4/21 N 10 H v v
89 ZASKIA PA P 1/4/2021 N 10 H v v
90 SYAQILLA A P 9/5/2021 N 9 H v v
91 M ABIZAR L 1/5/2021 N 9 H v v
92 KHAYLA Z P 20/6/21 N 8 H v v
93 AZKA ADI L 18/6/21 N 8 H v v
94 DIAH A P 19/6/21 N 8 H v v
95 AMALIYA HN P 10/6/2021 N 8 H v v
96 HABIBAH F P 22/6/21 N 8 H v v
97 ARUMI NZ P 6/6/2021 N 8 H v v
98 RAZKA A L 29/6/21 N 8 H v v
99 ABDIKA P L 17/6/21 S 8 M v v
100 M.ARDIANNUR L 8/6/2021 N 8 H v v
101 M.RIZAL L 22/7/21 N 7 H v v
102 M.RIZKI S L 8/8/2021 N 6 H v v
103 NUR AISYAH P 4/7/2021 N 7 H v v
104 RIZKYA P 26/7/21 N 7 H v v
105 ANDRI NK L 30/7/21 N 7 H v v
106 NUR ROSIDAH P 19/7/21 N 7 H v v
107 A.RIDHANI L 3/7/2021 N 7 H v v
108 RAFA A L 6/7/2021 N 7 H v v
109 M.FAQIH L 23/7/21 N 7 H v v
110 ZAHIRA N P 7/7/2021 N 7 H v v
111 AINUN N P 9/8/2021 N 6 H v v
112 M.AZAN L 27/9/21 N 5 TS v v
113 AISYAH N L P 27/8/21 N 6 H v v
114 QIRANA E P 20/8/21 N 6 H v v
115 ELVANO M L 10/9/21 N 5 TS TS TS
116 SEPTIA NA P 10/9/21 N 5 TS TS TS
117 L.ARFADIHILA L 6/10/21 N 4 TS TS TS
118 GAITSA R P 20/10/21 N 4 TS TS TS
119 KHOIROTUN P 14/9/21 N 5 TS TS TS
120 ZIDAN AL L 20/11/21 N 3 TS TS TS
121 IRSYAD L 20/12/21 N 2 TS TS TS
122 VELICIA P 14/10/21 N 4 TS TS TS
123 M.YUSUF A L 9/12/2021 N 2 TS TS TS
124 NUR BAGUS L 7/12/2021 N 2 TS TS TS
125 M.AL.AMIN L 2/1/2022 N 1 TS TS TS
126 M.BAHTIAR L 13/12/21 N 2 TS TS TS
127 M.ALFENDRA L 02/02/22 N 1 TS TS TS
128 LINTANG F L 09/02/22 N 2 TS TS TS
129 LAKEINA P 03/02/22 N 1 TS TS TS
130 SYAHIRA H P 08/02/22 N 1 TS TS TS
131 BIDARI P 11/01/22 N 2 TS TS TS
UAN BULANAN ANAK 0-2 TAHUN

Indikator Layanan
Pengukuran Tinggi

Kunjungan Rumah

Akses Air Bersih

Bagi Orang Tua

Jamban Sehat
Konseling Gizi

Kepemilikan

Kepemilikan

Pengasuhan
Kesehatan
Akta Lahir

Jaminan

(PAUD)
Badan

j k1 (L) k2 (P) l m n o p q

v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v v x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v v x
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v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
TS TS TS TS v v v x x
TS TS TS TS v v v x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
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TS TS TS TS v v x x x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
 FORMULIR 2.B. PEMANTAUAN BULANAN AN

BULAN : APRIL 2021

Status Umur dan

Jenis Kelamin (L/P)

Gizi Status Tikar
Tangg
Anak
No al (Norm
Regist Nama Lahir

Pengukuran Berat
No Anak al/Bur

Imunisasi Dasar
er Anak
uk/Ku

Pemberian
(KIA) (Tgl/Bl
rang/S Umur Hasil

Badan
n/Thn)
tuntin (Bulan (M/K/
g) ) H)

a b c d e f g h i

1 M. ARFA L 03/04/20 N 24 H v v
2 ZAFINA C.A. P 20/04/20 N 24 H v v
3 AISYAH N. P 14/04/20 N 24 H v v
4 M. NAZIL A.R. L 17/04/20 N 24 H v v
5 LAISYA P 13/04/20 N 24 H v v
6 ASHIMA P 02/04/20 N 24 H v v
7 M. ARFA L 03/04/20 N 24 H v v
8 YUKI KIANA P 18/05/20 N 23 H v v
9 AROYAN DILAN L 22/04/20 N 24 H v v
10 MERISA B.A. P 06/05/20 N 23 H v v
11 AUDI SYAHILA H. P 02/07/20 N 21 H v v
12 ZHAKIA ARZUMIS P 20/07/20 N 20 H v v
13 ARMAN F. L 09/06/20 N 21 H v v
14 M. DAVI L 15/05/20 N 22 H v v
15 M. DAVA L 15/05/20 N 23 H v v
16 UMI HANI P 29/05/20 N 23 H v v
17 DEFFIN R. L 17/04/20 N 24 H v v
18 DIANDRA NUR E. P 15/07/20 N 21 H v v
19 KHAIRUNISA P 23/07/20 N 21 H v v
20 M. ABIDZAR L 17/07/20 N 21 H v v
21 RUHANA ULUMI P 04/08/20 S 21 M v v
22 HANAN ALWI L 25/07/20 N 21 H v v
23 MAFAZA H. P 21/08/20 N 20 H v v
24 L. ABIZAR H. L 03/08/20 N 20 H v v
25 M. RAYYAN L 07/08/20 N 20 H v v
26 FANAZAIN L 25/07/20 N 21 H v v
27 M. ARTA L 05/09/20 N 19 H v v
28 M. ALFATIH L 03/09/20 N 19 H v v
29 ALENA Y. P 28/08/20 N 20 H v v
30 YUMNA A. P 15/09/20 N 19 H v v
31 SAFIRA P 15/09/20 N 19 H v v
32 ARNI G. P 24/10/20 N 16 H v v
33 ABIMANYU L 09/09/20 N 19 H v v
34 XKHAYLA S. P 04/09/20 N 19 H v v
35 AHMAD B. R. L 08/10/20 N 16 H v v
36 SHAFIA M. P 15/10/20 N 18 H v v
37 MUFIDA P 20/01/20 N 15 H v v
38 RAFIF A R L 14/12/20 N 16 H v v
39 RASYA O P 5/10/2019 N 18 H v v
40 M.RIFKI L 30/07/20 N 21 H v v
41 SYEHAN ZAIN L 6/11/2020 N 18 H v v
42 DYLAN ELKHAN L 9/12/2020 N 17 H v v
43 HANANIA P 17/10/20 N 19 H v v
44 A.BRILIAN L 8/10/2020 N 18 H v v
45 ZAHIRUL L 14/11/20 N 17 H v v
46 CARTO LITA L 17/11/20 N 17 H v v
47 M.RAMA F L 8/5/2020 N 21 H v v
48 M.FADLAN L 27/10/20 N 18 H v v
49 AFIFAH H P 10/11/2020 N 17 H v v
50 NUWAIRA A P 1/11/2020 N 17 H v v
51 M.MIZAN L 23/10/20 N 18 H v v
52 M.AZRIL R L 5/11/2020 N 17 H v v
53 NADIA O P 2/10/2020 N 18 H v v
54 NASYA P 2/11/2020 N 17 H v v
55 MUFIDA P 20/01/20 N 15 H v v
56 M.RAFA L 5/3/2020 N 24 H v v
57 DYLAN AL L 17/04/20 N 23 H v v
58 DEFFIN A L 20/06/20 N 22 H v v
59 M.ZULKIFLI L 20/06/20 N 22 H v v
60 ARSYAKA N P 7/7/2020 N 22 H v v
61 VANNO ZEAN L 25/07/20 N 22 H v v
62 AZLAN M L 12/8/2020 N 20 H v v
63 M.RAFA A L 16/07/20 N 22 H v v
64 M.ARKA L 9/9/2019 N 19 H v v
65 DEFITA P 6/12/2020 N 16 H v v
66 LAILA P 3/1/2021 S 15 M v v
67 M ALWISYAPUTR L 13/01/201 N 15 H v v
68 NATASYA P 9/12/2020 N 16 H v v
69 M.KEVIN L 25/12/20 N 16 H v v
70 EFRINA P 10/12/2020 N 16 H v v
71 DESI L P 22/12/20 N 16 H v v
72 M.ALBIYAN L 24/12/20 N 16 H v v
73 A.ALFARIZKI L 7/12/2020 N 15 H v v
74 RAFIF R L 14/12/20 N 15 H v v
75 KENZIE. A L 23/01/21 N 15 H v v
76 PRATAMA F L 4/2/2021 N 14 H v v
77 HANIFAH R P 13/02/21 N 14 H v v
78 NAFISA H P 10/2/2021 N 14 H v v
 79 KATINA P P 4/3/2021 N 12 H v v
80 IZZKY L 7/3/2021 N 2 H v v
81 NURUL F P 28/2/21 N 11 H v v
82 L.HAFAN L 22/2/21 N 11 H v v
83 HALWA P 1/4/2021 N 11 H v v
84 KENZO AS L 2/4/2021 N 10 H v v
85 CLAUDIAR P 12/3/2021 N 12 H v v
86 A SAURI L 23/4/21 N 11 H v v
87 MEGA TITI A P 15/5/21 N 10 H v v
88 M.YAHYA L 21/4/21 N 11 H v v
89 ZASKIA PA P 1/4/2021 N 11 H v v
90 SYAQILLA A P 9/5/2021 N 10 H v v
91 M ABIZAR L 1/5/2021 N 10 H v v
92 KHAYLA Z P 20/6/21 N 9 H v v
93 AZKA ADI L 18/6/21 N 9 H v v
94 DIAH A P 19/6/21 N 9 H v v
95 AMALIYA HN P 10/6/2021 N 9 H v v
96 HABIBAH F P 22/6/21 N 9 H v v
97 ARUMI NZ P 6/6/2021 N 9 H v v
98 RAZKA A L 29/6/21 N 9 H v v
99 ABDIKA P L 17/6/21 N 9 H v v
100 M.ARDIANNUR L 8/6/2021 N 9 H v v
101 M.RIZAL L 22/7/21 N 8 H v v
102 M.RIZKI S L 8/8/2021 N 7 H v v
103 NUR AISYAH P 4/7/2021 N 8 H v v
104 RIZKYA P 26/7/21 N 8 H v v
105 ANDRI NK L 30/7/21 N 8 H v v
106 NUR ROSIDAH P 19/7/21 N 8 H v v
107 A.RIDHANI L 3/7/2021 N 8 H v v
108 RAFA A L 6/7/2021 N 8 H v v
109 M.FAQIH L 23/7/21 N 8 H v v
110 ZAHIRA N P 7/7/2021 N 8 H v v
111 AINUN N P 9/8/2021 N 7 H v v
112 M.AZAN L 27/9/21 N 6 TS v v
113 AISYAH N L P 27/8/21 N 5 TS v v
114 QIRANA E P 20/8/21 N 5 TS v v
115 ELVANO M L 10/9/21 N 6 TS TS TS
116 SEPTIA NA P 10/9/21 N 6 TS TS TS
117 L.ARFADIHILA L 6/10/21 N 5 TS TS TS
118 GAITSA R P 20/10/21 N 5 TS TS TS
119 KHOIROTUN P 14/9/21 N 6 TS TS TS
120 ZIDAN AL L 20/11/21 N 4 TS TS TS
121 IRSYAD L 20/12/21 N 3 TS TS TS
122 VELICIA P 14/10/21 N 5 TS TS TS
123 M.YUSUF A L 9/12/2021 N 3 TS TS TS
124 NUR BAGUS L 7/12/2021 N 3 TS TS TS
125 M.AL.AMIN L 2/1/2022 N 2 TS TS TS
126 M.BAHTIAR L 13/12/21 N 3 TS TS TS
127 M.ALFENDRA L 02/02/22 N 2 TS TS TS
128 LINTANG F L 09/02/22 N 3 TS TS TS
129 LAKEINA P 03/02/22 N 2 TS TS TS
130 SYAHIRA H P 08/02/22 N 2 TS TS TS
131 BIDARI P 11/01/22 N 3 TS TS TS
132 ALMAIRA P 13/3/22 N 1 TS TS TS
133 M.SAQUELLE L 4/3/2022 N 1 TS TS TS
134 ASWA P 3/5/2021 S 12 M V V
UAN BULANAN ANAK 0-2 TAHUN

Indikator Layanan
Pengukuran Tinggi

Kunjungan Rumah

Akses Air Bersih

Bagi Orang Tua

Jamban Sehat
Konseling Gizi

Kepemilikan

Kepemilikan

Pengasuhan
Kesehatan
Akta Lahir

Jaminan

(PAUD)
Badan

j k1 (L) k2 (P) l m n o p q

v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
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v x x x v v v x x
v x x x v v v x x
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v x x x v v v v x
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v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v v x
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v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
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v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
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v x x x v v v x x
 v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
TS TS TS TS v v v x x
TS TS TS TS v v v x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
V V V V v v v v x
 FORMULIR 2.B. PEMANTAUAN BULANAN AN

BULAN : MEI 2022

Status Umur dan

Jenis Kelamin (L/P)

Gizi Status Tikar
Tangg
Anak
No al (Norm
Regist Nama Lahir

Pengukuran Berat
No Anak al/Bur

Imunisasi Dasar
er Anak
uk/Ku

Pemberian
(KIA) (Tgl/Bl
rang/S Umur Hasil

Badan
n/Thn)
tuntin (Bulan (M/K/
g) ) H)

a b c d e f g h i

1 YUKI KIANA P 18/05/20 N 24 H v v

2 MERISA B.A. P 06/05/20 N 24 H v v
3 AUDI SYAHILA H. P 02/07/20 N 22 H v v
4 ZHAKIA ARZUMIS P 20/07/20 N 21 H v v
5 ARMAN F. L 09/06/20 N 23 H v v
6 M. DAVI L 15/05/20 N 23 H v v
7 M. DAVA L 15/05/20 N 24 H v v
8 UMI HANI P 29/05/20 N 24 H v v
9 DIANDRA NUR E. P 15/07/20 N 22 H v v
10 KHAIRUNISA P 23/07/20 N 22 H v v
11 M. ABIDZAR L 17/07/20 N 22 H v v
12 RUHANA ULUMI P 04/08/20 S 22 M v v
13 HANAN ALWI L 25/07/20 N 22 H v v
14 MAFAZA H. P 21/08/20 N 21 H v v
15 L. ABIZAR H. L 03/08/20 N 21 H v v
16 M. RAYYAN L 07/08/20 N 21 H v v
17 FANAZAIN L 25/07/20 N 22 H v v
18 M. ARTA L 05/09/20 N 20 H v v
19 M. ALFATIH L 03/09/20 N 20 H v v
20 ALENA Y. P 28/08/20 N 21 H v v
21 YUMNA A. P 15/09/20 N 20 H v v
22 SAFIRA P 15/09/20 N 20 H v v
23 ARNI G. P 24/10/20 N 17 H v v
24 ABIMANYU L 09/09/20 N 20 H v v
25 XKHAYLA S. P 04/09/20 N 20 H v v
26 AHMAD B. R. L 08/10/20 N 17 H v v
27 SHAFIA M. P 15/10/20 N 19 H v v
28 MUFIDA P 20/01/20 N 16 H v v
29 RAFIF A R L 14/12/20 N 17 H v v
30 RASYA O P 5/10/2019 N 19 H v v
31 M.RIFKI L 30/07/20 N 22 H v v
32 SYEHAN ZAIN L 6/11/2020 N 19 H v v
33 DYLAN ELKHAN L 9/12/2020 N 18 H v v
34 HANANIA P 17/10/20 N 20 H v v
35 A.BRILIAN L 8/10/2020 N 19 H v v
36 ZAHIRUL L 14/11/20 N 18 H v v
37 CARTO LITA L 17/11/20 N 18 H v v
38 M.RAMA F L 8/5/2020 N 22 H v v
39 M.FADLAN L 27/10/20 N 19 H v v
40 AFIFAH H P 10/11/2020 N 18 H v v
41 NUWAIRA A P 1/11/2020 N 18 H v v
42 M.MIZAN L 23/10/20 N 19 H v v
43 M.AZRIL R L 5/11/2020 N 18 H v v
44 NADIA O P 2/10/2020 N 19 H v v
45 NASYA P 2/11/2020 N 18 H v v
46 MUFIDA P 20/01/20 N 16 H v v
47 DYLAN AL L 17/04/20 N 24 H v v
48 DEFFIN A L 20/06/20 N 23 H v v
49 M.ZULKIFLI L 20/06/20 N 23 H v v
50 ARSYAKA N P 7/7/2020 N 23 H v v
51 VANNO ZEAN L 25/07/20 N 23 H v v
52 AZLAN M L 12/8/2020 N 21 H v v
53 M.RAFA A L 16/07/20 N 23 H v v
54 M.ARKA L 9/9/2019 N 20 H v v
55 DEFITA P 6/12/2020 N 17 H v v
56 LAILA P 3/1/2021 S 16 M v v
57 M ALWISYAPUTR L 13/01/201 N 16 H v v
58 NATASYA P 9/12/2020 N 17 H v v
59 M.KEVIN L 25/12/20 N 17 H v v
60 EFRINA P 10/12/2020 N 17 H v v
61 DESI L P 22/12/20 N 17 H v v
62 M.ALBIYAN L 24/12/20 N 17 H v v
63 A.ALFARIZKI L 7/12/2020 N 16 H v v
64 RAFIF R L 14/12/20 N 16 H v v
65 KENZIE. A L 23/01/21 N 16 H v v
66 PRATAMA F L 4/2/2021 N 15 H v v
67 HANIFAH R P 13/02/21 N 15 H v v
68 NAFISA H P 10/2/2021 N 15 H v v
69 KATINA P P 4/3/2021 N 13 H v v
70 IZZKY L 7/3/2021 N 13 H v v
71 NURUL F P 28/2/21 N 12 H v v
72 L.HAFAN L 22/2/21 N 12 H v v
73 HALWA P 1/4/2021 N 12 H v v
74 KENZO AS L 2/4/2021 N 11 H v v
75 CLAUDIAR P 12/3/2021 N 13 H v v
76 A SAURI L 23/4/21 N 12 H v v
77 MEGA TITI A P 15/5/21 N 11 H v v
78 M.YAHYA L 21/4/21 N 12 H v v
 79 ZASKIA PA P 1/4/2021 N 12 H v v
80 SYAQILLA A P 9/5/2021 N 11 H v v
81 M ABIZAR L 1/5/2021 N 11 H v v
82 KHAYLA Z P 20/6/21 N 10 H v v
83 AZKA ADI L 18/6/21 N 10 H v v
84 DIAH A P 19/6/21 N 10 H v v
85 AMALIYA HN P 10/6/2021 N 10 H v v
86 HABIBAH F P 22/6/21 N 10 H v v
87 ARUMI NZ P 6/6/2021 N 10 H v v
88 RAZKA A L 29/6/21 N 10 H v v
89 ABDIKA P L 17/6/21 N 10 H v v
90 M.ARDIANNUR L 8/6/2021 N 10 H v v
91 M.RIZAL L 22/7/21 N 9 H v v
92 M.RIZKI S L 8/8/2021 N 8 H v v
93 NUR AISYAH P 4/7/2021 N 9 H v v
94 RIZKYA P 26/7/21 N 9 H v v
95 ANDRI NK L 30/7/21 N 9 H v v
96 NUR ROSIDAH P 19/7/21 N 9 H v v
97 A.RIDHANI L 3/7/2021 N 9 H v v
98 RAFA A L 6/7/2021 N 9 H v v
99 M.FAQIH L 23/7/21 N 9 H v v
100 ZAHIRA N P 7/7/2021 N 9 H v v
101 AINUN N P 9/8/2021 N 8 H v v
102 M.AZAN L 27/9/21 N 7 H v v
103 AISYAH N L P 27/8/21 N 6 TS v v
104 QIRANA E P 20/8/21 N 6 TS v v
105 ELVANO M L 10/9/21 N 7 H v v
106 SEPTIA NA P 10/9/21 N 7 H v v
107 L.ARFADIHILA L 6/10/21 N 6 TS TS TS
108 GAITSA R P 20/10/21 N 6 TS TS TS
109 KHOIROTUN P 14/9/21 N 7 H v v
110 ZIDAN AL L 20/11/21 N 5 TS TS TS
111 IRSYAD L 20/12/21 N 4 TS TS TS
112 VELICIA P 14/10/21 N 6 TS TS TS
113 M.YUSUF A L 9/12/2021 N 4 TS TS TS
114 NUR BAGUS L 7/12/2021 N 4 TS TS TS
115 M.AL.AMIN L 2/1/2022 N 3 TS TS TS
116 M.BAHTIAR L 13/12/21 N 4 TS TS TS
117 M.ALFENDRA L 02/02/22 N 3 TS TS TS
118 LINTANG F L 09/02/22 N 4 TS TS TS
119 LAKEINA P 03/02/22 N 3 TS TS TS
120 SYAHIRA H P 08/02/22 N 3 TS TS TS
121 BIDARI P 11/01/22 N 4 TS TS TS
122 ALMAIRA P 13/3/22 S 2 TS TS TS
123 M.SAQUELLE L 4/3/2022 N 2 TS TS TS
124 ASWA P 3/5/2021 S 13 M V V
125 ELSHAVA P 17/4/22 N 1 TS TS TS
UAN BULANAN ANAK 0-2 TAHUN

Indikator Layanan
Pengukuran Tinggi

Kunjungan Rumah

Akses Air Bersih

Bagi Orang Tua

Jamban Sehat
Konseling Gizi

Kepemilikan

Kepemilikan

Pengasuhan
Kesehatan
Akta Lahir

Jaminan

(PAUD)
Badan

j k1 (L) k2 (P) l m n o p q

v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v v v v v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
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v x x x v v v x x
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v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
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v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
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v x x x v v v x x
 v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
 v v v v v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
V V V V v v v v x
TS TS TS TS v v x x x
 Status BULAN : JUNI 2022

Jenis Kelamin (L/P)

Gizi Umur dan
No Tangga Anak Status Tikar
l Lahir (Norm
Regist Nama

Berat Badan
Pengukuran
Pemberian
No Anak al/Bur Umur Hasil

Imunisasi
er Anak

Dasar
(Tgl/Bl uk/Ku (Bulan (M/K/
(KIA)
n/Thn) rang/S ) H)
tuntin
g)
a b c d e f g h i

1 AUDI SYAHILA H. P 02/07/20 N 23 H v v

2 ZHAKIA ARZUMIS P 20/07/20 N 22 H v v
3 ARMAN F. L 09/06/20 N 24 H v v
4 M. DAVI L 15/05/20 N 24 H v v
5 DIANDRA NUR E. P 15/07/20 N 23 H v v
6 KHAIRUNISA P 23/07/20 N 23 H v v
7 M. ABIDZAR L 17/07/20 N 23 H v v
8 RUHANA ULUMI P 04/08/20 S 23 M v v
9 HANAN ALWI L 25/07/20 N 23 H v v
10 MAFAZA H. P 21/08/20 N 22 H v v
11 L. ABIZAR H. L 03/08/20 N 22 H v v
12 M. RAYYAN L 07/08/20 N 22 H v v
13 FANAZAIN L 25/07/20 N 23 H v v
14 M. ARTA L 05/09/20 N 21 H v v
15 M. ALFATIH L 03/09/20 N 21 H v v
16 ALENA Y. P 28/08/20 N 22 H v v
17 YUMNA A. P 15/09/20 N 21 H v v
18 SAFIRA P 15/09/20 N 21 H v v
19 ARNI G. P 24/10/20 N 18 H v v
20 ABIMANYU L 09/09/20 N 21 H v v
21 XKHAYLA S. P 04/09/20 N 21 H v v
22 AHMAD B. R. L 08/10/20 N 18 H v v
23 SHAFIA M. P 15/10/20 N 20 H v v
24 MUFIDA P 20/01/20 N 17 H v v
25 RAFIF A R L 14/12/20 N 18 H v v
26 RASYA O P 5/10/2019 N 20 H v v
27 M.RIFKI L 30/07/20 N 23 H v v
28 SYEHAN ZAIN L 6/11/2020 N 20 H v v
29 DYLAN ELKHAN L 9/12/2020 N 19 H v v
30 HANANIA P 17/10/20 N 21 H v v
31 A.BRILIAN L 8/10/2020 N 20 H v v
32 ZAHIRUL L 14/11/20 N 19 H v v
33 CARTO LITA L 17/11/20 N 19 H v v
34 M.RAMA F L 8/5/2020 N 23 H v v
35 M.FADLAN L 27/10/20 N 20 H v v
36 AFIFAH H P 10/11/2020 N 19 H v v
37 NUWAIRA A P 1/11/2020 N 19 H v v
38 M.MIZAN L 23/10/20 N 20 H v v
39 M.AZRIL R L 5/11/2020 N 19 H v v
40 NADIA O P 2/10/2020 N 20 H v v
41 NASYA P 2/11/2020 N 19 H v v
42 MUFIDA P 20/01/20 N 17 H v v
43 DEFFIN A L 20/06/20 N 24 H v v
44 M.ZULKIFLI L 20/06/20 N 24 H v v
45 ARSYAKA N P 7/7/2020 N 24 H v v
46 VANNO ZEAN L 25/07/20 N 24 H v v
47 AZLAN M L 12/8/2020 N 22 H v v
48 M.RAFA A L 16/07/20 N 24 H v v
49 M.ARKA L 9/9/2019 N 21 H v v
50 DEFITA P 6/12/2020 N 18 H v v
51 LAILA P 3/1/2021 S 17 M v v
52 M ALWISYAPUTR L 13/01/201 N 17 H v v
53 NATASYA P 9/12/2020 N 18 H v v
54 M.KEVIN L 25/12/20 N 18 H v v
55 EFRINA P 10/12/2020 N 18 H v v
56 DESI L P 22/12/20 N 18 H v v
57 M.ALBIYAN L 24/12/20 N 18 H v v
58 A.ALFARIZKI L 7/12/2020 N 17 H v v
59 RAFIF R L 14/12/20 N 17 H v v
60 KENZIE. A L 23/01/21 N 17 H v v
61 PRATAMA F L 4/2/2021 N 16 H v v
62 HANIFAH R P 13/02/21 N 16 H v v
63 NAFISA H P 10/2/2021 N 16 H v v
64 KATINA P P 4/3/2021 N 14 H v v
65 IZZKY L 7/3/2021 N 14 H v v
66 NURUL F P 28/2/21 N 13 H v v
67 L.HAFAN L 22/2/21 N 13 H v v
68 HALWA P 1/4/2021 N 13 H v v
69 KENZO AS L 2/4/2021 N 12 H v v
70 CLAUDIAR P 12/3/2021 N 14 H v v
71 A SAURI L 23/4/21 N 13 H v v
72 MEGA TITI A P 15/5/21 N 12 H v v
73 M.YAHYA L 21/4/21 N 13 H v v
74 ZASKIA PA P 1/4/2021 N 13 H v v
75 SYAQILLA A P 9/5/2021 N 12 H v v
76 M ABIZAR L 1/5/2021 N 12 H v v
77 KHAYLA Z P 20/6/21 N 11 H v v
78 AZKA ADI L 18/6/21 N 11 H v v
79 DIAH A P 19/6/21 N 11 H v v
80 AMALIYA HN P 10/6/2021 N 11 H v v
81 HABIBAH F P 22/6/21 N 11 H v v
82 ARUMI NZ P 6/6/2021 N 11 H v v
83 RAZKA A L 29/6/21 N 11 H v v
 84 ABDIKA P L 17/6/21 N 11 H v v
85 M.ARDIANNUR L 8/6/2021 N 11 H v v
86 M.RIZAL L 22/7/21 N 10 H v v
87 M.RIZKI S L 8/8/2021 N 9 H v v
88 NUR AISYAH P 4/7/2021 N 10 H v v
89 RIZKYA P 26/7/21 N 10 H v v
90 ANDRI NK L 30/7/21 N 10 H v v
91 NUR ROSIDAH P 19/7/21 N 10 H v v
92 A.RIDHANI L 3/7/2021 N 10 H v v
93 RAFA A L 6/7/2021 N 10 H v v
94 M.FAQIH L 23/7/21 N 10 H v v
95 ZAHIRA N P 7/7/2021 N 10 H v v
96 AINUN N P 9/8/2021 N 9 H v v
97 M.AZAN L 27/9/21 N 8 H v v
98 AISYAH N L P 27/8/21 N 7 H v v
99 QIRANA E P 20/8/21 N 7 H v v
100 ELVANO M L 10/9/21 N 8 H v v
101 SEPTIA NA P 10/9/21 N 8 H v v
102 L.ARFADIHILA L 6/10/21 N 7 H v v
103 GAITSA R P 20/10/21 N 7 H v v
104 KHOIROTUN P 14/9/21 N 8 H v v
105 ZIDAN AL L 20/11/21 N 6 TS TS TS
106 IRSYAD L 20/12/21 N 5 TS TS TS
107 VELICIA P 14/10/21 N 7 H v v
108 M.YUSUF A L 9/12/2021 N 5 TS TS TS
109 NUR BAGUS L 7/12/2021 N 5 TS TS TS
110 M.AL.AMIN L 2/1/2022 N 4 TS TS TS
111 M.BAHTIAR L 13/12/21 N 5 TS TS TS
112 M.ALFENDRA L 02/02/22 N 4 TS TS TS
113 LINTANG F L 09/02/22 N 5 TS TS TS
114 LAKEINA P 03/02/22 N 4 TS TS TS
115 SYAHIRA H P 08/02/22 N 4 TS TS TS
116 BIDARI P 11/01/22 N 5 TS TS TS
117 ALMAIRA P 13/3/22 N 3 TS TS TS
118 M.SAQUELLE L 4/3/2022 N 3 TS TS TS
119 ASWA P 3/5/2021 S 14 M V V
120 ELSHAVA P 17/4/22 N 2 TS TS TS
121 RAMADHANI L 26/4/22 N 2 TS TS TS
122 M.REYHAN L 26/4/22 N 2 TS TS TS
123 M.ALFIN L 23/4/22 N 2 TS TS TS
124 M.FADIL Z L 12/3/2022 N 3 TS TS TS
 Indikator Layanan

Bagi Orang Tua

Jamban Sehat
Konseling Gizi
Tinggi Badan

Kepemilikan

Kepemilikan

Pengasuhan
Pengukuran

Kunjungan

Kesehatan
Akta Lahir
Akses Air

Jaminan

(PAUD)
Rumah

Bersih
j k1 (L) k2 (P) l m n o p q

v x x x v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v v v v v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
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v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
 v v v v v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v x x x
v x x x v v x x x
v x x x v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
v x x x v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
V V V V v v v x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
 Status
Gizi BULAN : JUNI 2022

Jenis Kelamin (L/P)

No Tangga Anak Umur dan
l Lahir (Norm Status Tikar
Regist Nama

Berat Badan
Pengukuran
Pemberian
No Anak al/Bur Umur Hasil

Imunisasi
er Anak

Dasar
(Tgl/Bl uk/Ku (Bulan (M/K/
(KIA)
n/Thn) rang/S ) H)
tuntin
g)
a b c d e f g h i

1 AUDI SYAHILA H. P 02/07/20 N 24 H v v

2 ZHAKIA ARZUMIS P 20/07/20 N 23 H v v
3 DIANDRA NUR E. P 15/07/20 N 24 H v v
4 KHAIRUNISA P 23/07/20 N 24 H v v
5 M. ABIDZAR L 17/07/20 N 24 H v v
6 RUHANA ULUMI P 04/08/20 S 24 M v v
7 HANAN ALWI L 25/07/20 N 24 H v v
8 MAFAZA H. P 21/08/20 N 23 H v v
9 L. ABIZAR H. L 03/08/20 N 23 H v v
10 M. RAYYAN L 07/08/20 N 23 H v v
11 FANAZAIN L 25/07/20 N 24 H v v
12 M. ARTA L 05/09/20 N 22 H v v
13 M. ALFATIH L 03/09/20 N 22 H v v
14 ALENA Y. P 28/08/20 N 23 H v v
15 YUMNA A. P 15/09/20 N 22 H v v
16 SAFIRA P 15/09/20 N 22 H v v
17 ARNI G. P 24/10/20 N 19 H v v
18 ABIMANYU L 09/09/20 N 22 H v v
19 XKHAYLA S. P 04/09/20 N 22 H v v
20 AHMAD B. R. L 08/10/20 N 19 H v v
21 SHAFIA M. P 15/10/20 N 21 H v v
22 MUFIDA P 20/01/20 N 18 H v v
23 RAFIF A R L 14/12/20 N 19 H v v
24 RASYA O P 5/10/2019 N 21 H v v
25 M.RIFKI L 30/07/20 N 24 H v v
26 SYEHAN ZAIN L 6/11/2020 N 21 H v v
27 DYLAN ELKHAN L 9/12/2020 N 20 H v v
28 HANANIA P 17/10/20 N 22 H v v
29 A.BRILIAN L 8/10/2020 N 21 H v v
30 ZAHIRUL L 14/11/20 N 20 H v v
31 CARTO LITA L 17/11/20 N 20 H v v
32 M.RAMA F L 8/5/2020 N 24 H v v
33 M.FADLAN L 27/10/20 N 21 H v v
34 AFIFAH H P 10/11/2020 N 20 H v v
35 NUWAIRA A P 1/11/2020 N 20 H v v
36 M.MIZAN L 23/10/20 N 21 H v v
37 M.AZRIL R L 5/11/2020 N 20 H v v
38 NADIA O P 2/10/2020 N 21 H v v
39 NASYA P 2/11/2020 N 20 H v v
40 MUFIDA P 20/01/20 N 18 H v v
41 AZLAN M L 12/8/2020 N 23 H v v
42 M.ARKA L 9/9/2019 N 22 H v v
43 DEFITA P 6/12/2020 N 19 H v v
44 LAILA P 3/1/2021 S 18 M v v
45 M ALWISYAPUTR L 13/01/201 N 18 H v v
46 NATASYA P 9/12/2020 N 19 H v v
47 M.KEVIN L 25/12/20 N 19 H v v
48 EFRINA P 10/12/2020 N 19 H v v
49 DESI L P 22/12/20 N 19 H v v
50 M.ALBIYAN L 24/12/20 N 19 H v v
51 A.ALFARIZKI L 7/12/2020 N 18 H v v
52 RAFIF R L 14/12/20 N 18 H v v
53 KENZIE. A L 23/01/21 N 18 H v v
54 PRATAMA F L 4/2/2021 N 17 H v v
55 HANIFAH R P 13/02/21 N 17 H v v
56 NAFISA H P 10/2/2021 N 17 H v v
57 KATINA P P 4/3/2021 N 15 H v v
58 IZZKY L 7/3/2021 N 15 H v v
59 NURUL F P 28/2/21 N 14 H v v
60 L.HAFAN L 22/2/21 N 14 H v v
61 HALWA P 1/4/2021 N 14 H v v
62 KENZO AS L 2/4/2021 N 13 H v v
63 CLAUDIAR P 12/3/2021 N 15 H v v
64 A SAURI L 23/4/21 N 14 H v v
65 MEGA TITI A P 15/5/21 N 13 H v v
66 M.YAHYA L 21/4/21 N 14 H v v
67 ZASKIA PA P 1/4/2021 N 14 H v v
68 SYAQILLA A P 9/5/2021 N 13 H v v
69 M ABIZAR L 1/5/2021 N 13 H v v
70 KHAYLA Z P 20/6/21 N 12 H v v
71 AZKA ADI L 18/6/21 N 12 H v v
72 DIAH A P 19/6/21 N 12 H v v
73 AMALIYA HN P 10/6/2021 N 12 H v v
74 HABIBAH F P 22/6/21 N 12 H v v
75 ARUMI NZ P 6/6/2021 N 12 H v v
76 RAZKA A L 29/6/21 N 12 H v v
77 ABDIKA P L 17/6/21 N 12 H v v
78 M.ARDIANNUR L 8/6/2021 N 12 H v v
79 M.RIZAL L 22/7/21 N 11 H v v
80 M.RIZKI S L 8/8/2021 N 10 H v v
81 NUR AISYAH P 4/7/2021 N 11 H v v
82 RIZKYA P 26/7/21 N 11 H v v
83 ANDRI NK L 30/7/21 N 11 H v v
 84 NUR ROSIDAH P 19/7/21 N 11 H v v
85 A.RIDHANI L 3/7/2021 N 11 H v v
86 RAFA A L 6/7/2021 N 11 H v v
87 M.FAQIH L 23/7/21 N 11 H v v
88 ZAHIRA N P 7/7/2021 N 11 H v v
89 AINUN N P 9/8/2021 N 10 H v v
90 M.AZAN L 27/9/21 N 9 H v v
91 AISYAH N L P 27/8/21 N 8 H v v
92 QIRANA E P 20/8/21 N 8 H v v
93 ELVANO M L 10/9/21 N 9 H v v
94 SEPTIA NA P 10/9/21 N 9 H v v
95 L.ARFADIHILA L 6/10/21 N 8 H v v
96 GAITSA R P 20/10/21 N 8 H v v
97 KHOIROTUN P 14/9/21 N 9 H v v
98 ZIDAN AL L 20/11/21 N 7 H v v
99 IRSYAD L 20/12/21 N 6 TS TS TS
100 VELICIA P 14/10/21 N 8 H v v
101 M.YUSUF A L 9/12/2021 N 6 TS TS TS
102 NUR BAGUS L 7/12/2021 N 6 TS TS TS
103 M.AL.AMIN L 2/1/2022 N 5 TS TS TS
104 M.BAHTIAR L 13/12/21 N 6 TS TS TS
105 M.ALFENDRA L 02/02/22 N 5 TS TS TS
106 LINTANG F L 09/02/22 N 6 TS TS TS
107 LAKEINA P 03/02/22 N 5 TS TS TS
108 SYAHIRA H P 08/02/22 N 5 TS TS TS
109 BIDARI P 11/01/22 N 6 TS TS TS
110 ALMAIRA P 13/3/22 N 4 TS TS TS
111 M.SAQUELLE L 4/3/2022 N 4 TS TS TS
112 ASWA P 3/5/2021 S 15 M v v
113 ELSHAVA P 17/4/22 N 3 TS TS TS
114 RAMADHANI L 26/4/22 N 3 TS TS TS
115 M.REYHAN L 26/4/22 N 3 TS TS TS
116 M.ALFIN L 23/4/22 N 3 TS TS TS
117 M.FADIL Z L 12/3/2022 N 4 TS TS TS
118 MILYANI P 22/6/22 N 1 TS TS TS
119 M.AZKA A L 7/6/2022 N 1 TS TS TS
120 M.ARSHAKA L 22/6/22 N 1 TS TS TS
121 RASHFIKI L 20/6/22 N 1 TS TS TS
122 AGISYAH P 16/6/22 N 1 TS TS TS
123 M.NAUFAL L 24/6/22 N 1 TS TS TS
124 DIFANKA L 9/5/2022 N 2 TS TS TS
 Indikator Layanan

Kepemilikan

Kepemilikan

Pengasuhan
Pengukuran

Kunjungan

Kesehatan
Orang Tua

Akta Lahir
Konseling

Akses Air
Gizi Bagi

Jaminan
Jamban

(PAUD)
Rumah
Badan

Bersih
Tinggi

Sehat
j k1 (L) k2 (P) l m n o p q

v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v v v v v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
 v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v x x x
v x x x v v x x x
v x x x v v x x x
v x x x v v x x x
TS TS TS TS v v x x x
v x x x v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
v x x V v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x x x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
TS TS TS TS v v x v x
 BULAN : AGUS 2022
Status
Umur dan

Jenis Kelamin (L/P)

Gizi
No Tangga Anak Status Tikar
l Lahir (Norm

Imunisasi Dasar
Regist Nama
No Anak al/Bur

Berat Badan
Pengukuran
Pemberian
er Anak
(Tgl/Bl uk/Ku Umur Hasil
(KIA)
n/Thn) rang/S (Bulan (M/K/
tuntin ) H)
g)
a b c d e f g h i

1 ZHAKIA ARZUMI P 20/07/20 N 24 H v v

2 MAFAZA H. P 21/08/20 N 24 H v v
3 L. ABIZAR H. L 03/08/20 N 24 H v v
4 M. RAYYAN L 07/08/20 N 24 H v v
5 M. ARTA L 05/09/20 N 23 H v v
6 M. ALFATIH L 03/09/20 N 23 H v v
7 ALENA Y. P 28/08/20 N 24 H v v
8 YUMNA A. P 15/09/20 N 23 H v v
9 SAFIRA P 15/09/20 N 23 H v v
10 ARNI G. P 24/10/20 N 20 H v v
11 ABIMANYU L 09/09/20 N 23 H v v
12 XKHAYLA S. P 04/09/20 N 23 H v v
13 AHMAD B. R. L 08/10/20 N 20 H v v
14 SHAFIA M. P 15/10/20 N 22 H v v
15 MUFIDA P 20/01/20 N 19 H v v
16 RAFIF A R L 14/12/20 N 20 H v v
17 RASYA O P 5/10/2019 N 22 H v v
18 SYEHAN ZAIN L 6/11/2020 N 22 H v v
19 DYLAN ELKHAN L 9/12/2020 N 21 H v v
20 HANANIA P 17/10/20 N 23 H v v
21 A.BRILIAN L 8/10/2020 N 22 H v v
22 ZAHIRUL L 14/11/20 N 21 H v v
23 CARTO LITA L 17/11/20 N 21 H v v
24 M.FADLAN L 27/10/20 N 22 H v v
25 AFIFAH H P 10/11/2020 N 21 H v v
26 NUWAIRA A P 1/11/2020 N 21 H v v
27 M.MIZAN L 23/10/20 N 22 H v v
28 M.AZRIL R L 5/11/2020 N 21 H v v
29 NADIA O P 2/10/2020 N 21 H v v
30 NASYA P 2/11/2020 N 21 H v v
31 MUFIDA P 20/01/20 N 19 H v v
32 AZLAN M L 12/8/2020 N 24 H v v
33 M.ARKA L 9/9/2019 N 23 H v v
34 DEFITA P 6/12/2020 N 20 H v v
35 LAILA P 3/1/2021 S 19 M v v
36 M ALWISYAPUT L 13/01/201 N 19 H v v
37 NATASYA P 9/12/2020 N 20 H v v
38 M.KEVIN L 25/12/20 N 20 H v v
39 EFRINA P 10/12/2020 N 20 H v v
40 DESI L P 22/12/20 N 20 H v v
41 M.ALBIYAN L 24/12/20 N 20 H v v
42 A.ALFARIZKI L 7/12/2020 N 19 H v v
43 RAFIF R L 14/12/20 N 19 H v v
44 KENZIE. A L 23/01/21 N 19 H v v
45 PRATAMA F L 4/2/2021 N 18 H v v
46 HANIFAH R P 13/02/21 N 18 H v v
47 NAFISA H P 10/2/2021 N 18 H v v
48 KATINA P P 4/3/2021 N 16 H v v
49 IZZKY L 7/3/2021 N 16 H v v
50 NURUL F P 28/2/21 N 15 H v v
51 L.HAFAN L 22/2/21 N 15 H v v
52 HALWA P 1/4/2021 N 15 H v v
53 KENZO AS L 2/4/2021 N 14 H v v
54 CLAUDIAR P 12/3/2021 N 16 H v v
55 A SAURI L 23/4/21 N 15 H v v
56 MEGA TITI A P 15/5/21 N 14 H v v
57 M.YAHYA L 21/4/21 N 15 H v v
58 ZASKIA PA P 1/4/2021 N 15 H v v
59 SYAQILLA A P 9/5/2021 N 14 H v v
60 M ABIZAR L 1/5/2021 N 14 H v v
61 KHAYLA Z P 20/6/21 N 13 H v v
62 AZKA ADI L 18/6/21 N 13 H v v
63 DIAH A P 19/6/21 N 13 H v v
64 AMALIYA HN P 10/6/2021 N 13 H v v
65 HABIBAH F P 22/6/21 N 13 H v v
66 ARUMI NZ P 6/6/2021 N 13 H v v
67 RAZKA A L 29/6/21 N 13 H v v
68 ABDIKA P L 17/6/21 N 13 H v v
69 M.ARDIANNUR L 8/6/2021 N 13 H v v
70 M.RIZAL L 22/7/21 N 12 H v v
71 M.RIZKI S L 8/8/2021 N 11 H v v
72 NUR AISYAH P 4/7/2021 N 12 H v v
73 RIZKYA P 26/7/21 N 12 H v v
74 ANDRI NK L 30/7/21 N 12 H v v
75 NUR ROSIDAH P 19/7/21 N 12 H v v
76 A.RIDHANI L 3/7/2021 N 12 H v v
77 RAFA A L 6/7/2021 N 12 H v v
78 M.FAQIH L 23/7/21 N 12 H v v
79 ZAHIRA N P 7/7/2021 N 12 H v v
80 AINUN N P 9/8/2021 N 11 H v v
81 M.AZAN L 27/9/21 N 10 H v v
 82 AISYAH N L P 27/8/21 N 9 H v v
83 QIRANA E P 20/8/21 N 9 H v v
84 ELVANO M L 10/9/21 N 10 H v v
85 SEPTIA NA P 10/9/21 N 10 H v v
86 L.ARFADIHILA L 6/10/21 N 9 H v v
87 GAITSA R P 20/10/21 N 9 H v v
88 KHOIROTUN P 14/9/21 N 10 H v v
89 ZIDAN AL L 20/11/21 N 8 H v v
90 IRSYAD L 20/12/21 N 7 H v v
91 VELICIA P 14/10/21 N 9 H v v
92 M.YUSUF A L 9/12/2021 N 7 H v v
93 NUR BAGUS L 7/12/2021 N 7 H v v
94 M.AL.AMIN L 2/1/2022 N 6 TS TS TS
95 M.BAHTIAR L 13/12/21 N 7 H v v
96 M.ALFENDRA L 02/02/22 N 6 TS TS TS
97 LINTANG F L 09/02/22 N 7 H v v
98 LAKEINA P 03/02/22 N 6 TS TS TS
99 SYAHIRA H P 08/02/22 N 6 TS TS TS
100 BIDARI P 11/01/22 N 7 TS TS TS
101 ALMAIRA P 13/3/22 N 5 TS TS TS
102 M.SAQUELLE L 4/3/2022 N 5 TS TS TS
103 ASWA P 3/5/2021 S 16 M v v
104 ELSHAVA P 17/4/22 N 4 TS TS TS
105 RAMADHANI L 26/4/22 N 4 TS TS TS
106 M.REYHAN L 26/4/22 N 4 TS TS TS
107 M.ALFIN L 23/4/22 N 4 TS TS TS
108 M.FADIL Z L 12/3/2022 N 5 TS TS TS
109 MILYANI P 22/6/22 N 2 TS TS TS
110 M.AZKA A L 7/6/2022 N 2 TS TS TS
111 M.ARSHAKA L 22/6/22 N 2 TS TS TS
112 RASHFIKI L 20/6/22 N 2 TS TS TS
113 AGISYAH P 16/6/22 N 2 TS TS TS
114 M.NAUFAL L 24/6/22 N 2 TS TS TS
115 DIFANKA L 9/5/2022 N 3 TS TS TS
116 M.RAYYANL L 12/7/2022 N 1 TS TS TS
117 ARDANI C L 20/7/22 N 1 TS TS TS
 Indikator Layanan

Akses Air Bersih

Bagi Orang Tua

Jamban Sehat
Konseling Gizi
Tinggi Badan

Kepemilikan

Kepemilikan

Pengasuhan
Pengukuran

Kunjungan

Kesehatan
Akta Lahir

Jaminan

(PAUD)
j k1 (L) k2 (P)
Rumah
l m n o p q

v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v v v v v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v v x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
v x x x v v v x x
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 BULAN : SEP 2022
Status Umur dan

Jenis Kelamin (L/P)

Gizi Status Tikar
Tangga Anak
No
l Lahir (Norm
Regist

Imunisasi Dasar
No er Nama Anak Anak al/Bur

Pemberian
(Tgl/Bl uk/Ku Umur Hasil
(KIA) n/Thn) rang/S (Bulan (M/K/
tuntin ) H)
g)

a b c d e f g h

1 M. ARTA L 05/09/20 N 24 H v
2 M. ALFATIH L 03/09/20 N 24 H v
3 YUMNA A. P 15/09/20 N 24 H v
4 SAFIRA P 15/09/20 N 24 H v
5 ARNI G. P 24/10/20 N 21 H v
6 ABIMANYU L 09/09/20 N 24 H v
7 XKHAYLA S. P 04/09/20 N 24 H v
8 AHMAD B. R. L 08/10/20 N 21 H v
9 SHAFIA M. P 15/10/20 N 23 H v
10 MUFIDA P 20/01/20 N 20 H v
11 RAFIF A R L 14/12/20 N 21 H v
12 RASYA O P 5/10/2019 N 23 H v
13 SYEHAN ZAIN L 6/11/2020 N 23 H v
14 DYLAN ELKHAN L 9/12/2020 N 22 H v
15 HANANIA P 17/10/20 N 24 H v
16 A.BRILIAN L 8/10/2020 N 23 H v
17 ZAHIRUL L 14/11/20 N 22 H v
18 CARTO LITA L 17/11/20 N 22 H v
19 M.FADLAN L 27/10/20 N 23 H v
20 AFIFAH H P 10/11/2020 N 22 H v
21 NUWAIRA A P 1/11/2020 N 22 H v
22 M.MIZAN L 23/10/20 N 23 H v
23 M.AZRIL R L 5/11/2020 N 22 H v
24 NADIA O P 2/10/2020 N 22 H v
25 NASYA P 2/11/2020 N 22 H v
26 MUFIDA P 20/01/20 N 20 H v
27 M.ARKA L 9/9/2019 N 24 H v
28 DEFITA P 6/12/2020 N 21 H v
29 LAILA P 3/1/2021 S 20 M v
30 M ALWISYAPUTRA L 13/01/201 N 20 H v
31 NATASYA P 9/12/2020 N 21 H v
32 M.KEVIN L 25/12/20 N 21 H v
33 EFRINA P 10/12/2020 N 21 H v
34 DESI L P 22/12/20 N 21 H v
35 M.ALBIYAN L 24/12/20 N 21 H v
36 A.ALFARIZKI L 7/12/2020 N 20 H v
37 RAFIF R L 14/12/20 N 20 H v
38 KENZIE. A L 23/01/21 N 20 H v
39 PRATAMA F L 4/2/2021 N 19 H v
40 HANIFAH R P 13/02/21 N 19 H v
41 NAFISA H P 10/2/2021 N 19 H v
42 KATINA P P 4/3/2021 N 17 H v
43 IZZKY L 7/3/2021 N 17 H v
44 NURUL F P 28/2/21 N 16 H v
45 L.HAFAN L 22/2/21 N 16 H v
46 HALWA P 1/4/2021 N 16 H v
47 KENZO AS L 2/4/2021 N 15 H v
48 CLAUDIAR P 12/3/2021 N 17 H v
49 A SAURI L 23/4/21 N 16 H v
50 MEGA TITI A P 15/5/21 N 15 H v
51 M.YAHYA L 21/4/21 N 16 H v
52 ZASKIA PA P 1/4/2021 N 16 H v
53 SYAQILLA A P 9/5/2021 N 15 H v
54 M ABIZAR L 1/5/2021 N 15 H v
55 KHAYLA Z P 20/6/21 N 14 H v
56 AZKA ADI L 18/6/21 N 14 H v
57 DIAH A P 19/6/21 N 14 H v
58 AMALIYA HN P 10/6/2021 N 14 H v
59 HABIBAH F P 22/6/21 N 14 H v
60 ARUMI NZ P 6/6/2021 N 14 H v
61 RAZKA A L 29/6/21 N 14 H v
62 ABDIKA P L 17/6/21 N 14 H v
63 M.ARDIANNUR L 8/6/2021 N 14 H v
64 M.RIZAL L 22/7/21 N 13 H v
65 M.RIZKI S L 8/8/2021 N 12 H v
66 NUR AISYAH P 4/7/2021 N 13 H v
67 RIZKYA P 26/7/21 N 13 H v
68 ANDRI NK L 30/7/21 N 13 H v
69 NUR ROSIDAH P 19/7/21 N 13 H v
70 A.RIDHANI L 3/7/2021 N 13 H v
71 RAFA A L 6/7/2021 N 13 H v
72 M.FAQIH L 23/7/21 N 13 H v
73 ZAHIRA N P 7/7/2021 N 13 H v
74 AINUN N P 9/8/2021 N 12 H v
75 M.AZAN L 27/9/21 N 11 H v
76 AISYAH N L P 27/8/21 N 10 H v
77 QIRANA E P 20/8/21 N 10 H v
78 ELVANO M L 10/9/21 N 11 H v
79 SEPTIA NA P 10/9/21 N 11 H v
80 L.ARFADIHILA L 6/10/21 N 10 H v
 81 GAITSA R P 20/10/21 N 10 H v
82 KHOIROTUN P 14/9/21 N 11 H v
83 ZIDAN AL L 20/11/21 N 9 H v
84 IRSYAD L 20/12/21 N 8 H v
85 VELICIA P 14/10/21 N 10 H v
86 M.YUSUF A L 9/12/2021 N 8 H v
87 NUR BAGUS L 7/12/2021 N 8 H v
88 M.AL.AMIN L 2/1/2022 N 7 H v
89 M.BAHTIAR L 13/12/21 N 8 H v
90 M.ALFENDRA L 02/02/22 N 7 H v
91 LINTANG F L 09/02/22 N 8 H v
92 LAKEINA P 03/02/22 N 7 H v
93 SYAHIRA H P 08/02/22 N 7 H v
94 BIDARI P 11/01/22 N 8 H v
95 ALMAIRA P 13/3/22 N 6 TS TS
96 M.SAQUELLE L 4/3/2022 N 6 TS TS
97 ASWA P 3/5/2021 S 17 M v
98 ELSHAVA P 17/4/22 N 5 TS TS
99 RAMADHANI L 26/4/22 N 5 TS TS
100 M.REYHAN L 26/4/22 N 5 TS TS
101 M.ALFIN L 23/4/22 N 5 TS TS
102 M.FADIL Z L 12/3/2022 N 6 TS TS
103 MILYANI P 22/6/22 N 3 TS TS
104 M.AZKA A L 7/6/2022 N 3 TS TS
105 M.ARSHAKA L 22/6/22 N 3 TS TS
106 RASHFIKI L 20/6/22 N 3 TS TS
107 AGISYAH P 16/6/22 N 3 TS TS
108 M.NAUFAL L 24/6/22 N 3 TS TS
109 DIFANKA L 9/5/2022 N 4 TS TS
110 M.RAYYANL L 12/7/2022 N 2 TS TS
111 ARDANI C L 20/7/22 N 1 TS TS
112 M.ZAELANI L 2/7/2022 N 1 TS TS
113 M.KURNIA L 11/8/2022 N 1 TS TS
114 RAISA NAHDA P 1/7/2022 N 1 TS TS
115 AINUN N P 9/8/2022 N 1 TS TS
2022

Indikator Layanan

Konseling Gizi Bagi

Kepemilikan Akses
Pengukuran Tinggi

Kunjungan Rumah
Pengukuran Berat

Jamban Sehat
Kepemilikan

Pengasuhan
Kesehatan
Orang Tua

Akta Lahir
Air Bersih

Jaminan

(PAUD)
Badan
Badan

i j k1 (L) k2 (P) l m n o p q

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